Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 0014413 | CO |
NPI | 1366926065 |
---|---|
Provider Name | Jeremy James Kujawa |
First Address | Wilsonville, OR 97070-9697 |
Second Address | Centennial, CO 80121-3539 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2018 |
Last Update Date | 18/09/2018 |